Open surgical treatment of a non-thumb carpometacarpal (CMC) joint dislocation, including internal fixation when performed, billed per joint.

Verified May 8, 2026 · 7 sources ↓

Medicare: $535.42
Work RVU: 6.89
Global, days: 90
Region: Hand

Drawn from CMSNIHAbosFastrvuAAPC

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 7 cited references ↓

Identify the specific CMC joint(s) treated by number (e.g., index, long, ring, small finger CMC)
State the surgical approach explicitly as open — do not use generic language like 'standard approach'
Document whether internal fixation (K-wires, screws, plates) or external fixation was placed, and if so, the hardware type and configuration
Confirm no thumb CMC involvement — if thumb CMC is also treated, it requires a separate code (26665)
Document pre-reduction and post-reduction imaging confirming dislocation and restoration of alignment
Specify whether this is an acute, delayed, or chronic dislocation, as delayed/chronic presentations may shift coding to 26686

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 51 Multiple procedures 58 Staged or related 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 26685 covers open reduction of a carpometacarpal dislocation at any CMC joint except the thumb, with or without internal or external fixation. It is billed per joint treated. The code explicitly excludes the thumb CMC (Bennett fracture territory — see 26665) and excludes complex, multiple, or delayed reductions (see 26686). If the operative note documents both a fracture and a dislocation at the same CMC joint, the fracture may warrant a separate code (e.g., 26615 for a metacarpal fracture); audit teams flag operative reports where the coder has applied 26685 to a fracture-dislocation that requires two distinct CPT codes.

The 90-day global period means all routine post-op care through day 90 is included — no separate office visits for wound checks, K-wire removal, or cast management unless an unrelated condition is treated (modifier 24) or a distinct new problem arises (modifier 25). If the patient returns to the OR for a complication related to the original CMC repair, bill 26685 or the appropriate procedure with modifier 78. An unrelated OR procedure in the global window uses modifier 79.

Distinguish 26685 from 26676 (percutaneous skeletal fixation of non-thumb CMC dislocation with manipulation) — 26685 requires an open approach. Document the open approach explicitly; operative notes that omit approach language are common audit targets. When multiple non-thumb CMC joints are dislocated and each is treated via separate open reduction in the same session, evaluate whether 26686 (complex, multiple, or delayed) better describes the work before billing 26685 with modifier 51.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (6.89) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (16.03) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	6.89
Practice expense RVU	7.95
Malpractice RVU	1.19
Total RVU	16.03
Medicare national rate	$535.42
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$535.42
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 26685 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Unbundling denied: fracture-dislocation coded only as 26685 when a separate fracture code (e.g., 26615) was also required and not linked correctly
Wrong code level: payer downcodes 26685 to 26676 (percutaneous) when operative note fails to explicitly state the open approach
Global period conflict: post-op office visits billed without modifier 24 or 25 during the 90-day global window
Missing laterality documentation: payers requiring LT/RT modifier reject claims that omit side when multiple claims are on file for the same date
Diagnosis mismatch: ICD-10 code reflects a fracture only (S62.xx) rather than a dislocation (S63.xx), conflicting with 26685

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01Can 26685 and 26686 be billed together for multiple CMC dislocations in the same hand?

No. 26686 covers complex, multiple, or delayed reductions and replaces 26685 when the work rises to that level. Bill 26686 alone for complex or multiple CMC dislocations; do not stack 26685 and 26686 on the same claim for the same hand.

02When does a CMC fracture-dislocation require two codes instead of just 26685?

If the operative report documents open treatment of both a carpometacarpal dislocation and a discrete metacarpal fracture at the same joint, a separate fracture code (e.g., 26615 for open metacarpal fracture) may be billable alongside 26685. Apply modifier 59 or XS to the fracture code to bypass NCCI bundling edits, and ensure the operative note supports distinct work for each.

03Is modifier 50 appropriate for bilateral CMC dislocations?

Only if both hands are treated in the same operative session and payer policy accepts modifier 50 for hand surgery. Some payers prefer LT/RT on separate line items. Confirm payer-specific bilateral billing rules before submitting modifier 50.

04What is the difference between 26685 and 26676?

26676 is percutaneous skeletal fixation with manipulation — no open incision. 26685 requires an open surgical approach. The operative note must state the approach clearly; payers will downcode to 26676 if open entry is not documented.

05Does 26685 include the cost of K-wire or screw fixation hardware?

The code includes internal fixation 'when performed' — meaning the surgical work of placing fixation is bundled into 26685. Implant costs may be separately billable as a supply depending on facility vs. non-facility setting, but the fixation service itself is not separately reportable.

06How does the 90-day global period affect post-op K-wire removal?

Routine K-wire removal within the 90-day global is included in 26685 and is not separately billable. If the removal requires a return to the OR due to an unplanned complication, use modifier 78 on the removal code. If the patient presents after day 90, the global is closed and the visit bills normally.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the open approach by name, the specific CMC joint number(s) treated, fixation hardware used, and the laterality from dictation — preventing the most common denial triggers: a vague 'open reduction' note that payers reclassify as percutaneous, and missing laterality that blocks payment when bilateral claims are submitted.

See how Mira captures CPT 26685 documentation